POSTOPERATIVE COMPLICATIONS AFTER TONSILLECTOMY AND ADENOIDECTOMY IN CHILDREN WITH DOWN-SYNDROME

Objective: To compare the postoperative course and complications after tonsillectomy or tonsillectomy and adenoidectomy in children with Dow n syndrome (group 1) with the postoperative course and complications i n children in a control group (group 2). Design: Retrospective review of medical records for the period January 1, 1986, through March 30, 1 996. Setting: Tertiary care children's hospital. Patients: The study i ncluded 87 children in group 1 and 64 children in group 2 matched for age, sex, and year of surgery. Intervention: Tonsillectomy and adenoid ectomy (group 1, 79 children; group 2, 57 children) and tonsillectomy (group 1, 8 children; group 2, 7 children). Main Outcome Measures: Len gth of hospitalization and postoperative complications. Results: The l ength of hospitalization was significantly increased for the children in group 1 compared with that of children in group 2 (1.6 vs 0.80 days ; P=.001, Mann-Whitney U test). Twenty-two children (25%) in group 1 r equired airway management or observation in the pediatric intensive ca re unit compared with no children in group 2 who required such care (P <.001, Fisher exact test). None of the children in either group requir ed reintubation, continuous positive airway pressure, or tracheotomy. Respiratory complications requiring intervention were 5 times more lik ely in group 1 (22 [25%] vs 3 [5%]; P<.001, Fisher exact test). The me dian time until intake of clear liquids and duration of intravenous th erapy were significantly increased in group 1 compared with group 2 (5 .0 vs 4.0 hours, P=.03; 23.5 vs 16.0 hours, P=.001, respectively; Mann -Whitney U test). Conclusions: Although tonsillectomy and adenoidectom y can be performed safely in children with Down syndrome, the rate of postoperative respiratory complications is higher and the duration unt il adequate oral intake is resumed is longer. We therefore recommend t hat children with Down syndrome be admitted to the hospital overnight after undergoing tonsillectomy and adenoidectomy.